Silent duodenal perforation. A difficult diagnosis in iatrogenic barbiturate coma

Iatrogenic barbiturate coma for the control of intracranial hypertension is a relatively new addition to the neurosurgeon's therapeutic armamentarium. Although initial studies are quite promising, the induction of coma, especially for prolonged periods (ranging from days to weeks), is a major therapeutic endeavor which requires sophisticated monitoring of both neurological and physiological function. A multidisciplinary approach prevents many possible complications of this form of therapy and facilitates treatment when untoward physiological complications do occur. The following case report illustrates one such complication.